Detailed Abstract
[BP Best video Presentation - Biliary & Pancreas (Pancreas Disease/Surgery)]
[BP BV-S1] Venous Resection With Peritoneal Patch Reconstruction During Pancreatoduodenectomy
Nikola VLADOV1, Radoslav KOSTADINOV1, Tsvetan TRICHKOV1, Vassil MIHAYLOV1, Stefan MARVAKOV1, Ivan IVANOV1
1Department of Liver Transplantation and Hepatobiliary Surgery, Military Medical Academy Sofia, Bulgaria
Background : Most patients with pancreatic cancer present at an advanced stage. Surgery offers the only potential for cure. Vascular resection for borderline resectable pancreatic cancer has proven feasible and offer survival benefit. The purpose of the presentation is to present the feasibility and safety of portal vein reconstruction with peritoneal patch during pancreatic surgery.
Methods : A review of a prospectively maintained database of patients who underwent pancreatic surgery in a tertiary HPB unit was performed. For the period 2018-2023 we identified 9 patients, who underwent portal vein resection (PVR) and peritoneal patch reconstruction during pancreatic surgery. Falciform ligament flap was used as an autologous graft in all the cases. In 8 patients, the PVR occurred during pylorus-preserving pancreatoduodenectomy (PPPD). In one patient, portal vein reconstruction was performed due to necrosis of the portal vein wall in the aspect of acute necrotizing pancreatitis. We performed an analysis of the perioperative outcomes of patients who underwent PPPD and PVR with falciform flap reconstruction.
Results : The indication for PPPD was pancreatic adenocarcinoma in all 8 patients. The level of reconstruction was portal vein (n=2), superior mesenteric vein (n=1) and porto-mesenteric confluence (n=5). The average clamping time was 27 minutes (18-34 minutes). Intraoperative blood transfusion was necessitated in 3 cases. Major postoperative morbidity (Clavien-Dindo >= 3) was registered in two patients. One patient developed severe postoperative pancreatic fistula and delayed haemorrhage, who later succumbed due to poly organ failure. Histology analysis confirmed true venous invasion in all cases.
Conclusions : Peritoneal patch reconstruction for portal vein resection has proven valuable and cost-effective. Peritoneal patches seem appealing for vascular reconstruction due to their availability in the same operative field. The peritoneum is more resistant to infection than synthetic grafts, and the mesothelial lining is non-thrombogenic.
Methods : A review of a prospectively maintained database of patients who underwent pancreatic surgery in a tertiary HPB unit was performed. For the period 2018-2023 we identified 9 patients, who underwent portal vein resection (PVR) and peritoneal patch reconstruction during pancreatic surgery. Falciform ligament flap was used as an autologous graft in all the cases. In 8 patients, the PVR occurred during pylorus-preserving pancreatoduodenectomy (PPPD). In one patient, portal vein reconstruction was performed due to necrosis of the portal vein wall in the aspect of acute necrotizing pancreatitis. We performed an analysis of the perioperative outcomes of patients who underwent PPPD and PVR with falciform flap reconstruction.
Results : The indication for PPPD was pancreatic adenocarcinoma in all 8 patients. The level of reconstruction was portal vein (n=2), superior mesenteric vein (n=1) and porto-mesenteric confluence (n=5). The average clamping time was 27 minutes (18-34 minutes). Intraoperative blood transfusion was necessitated in 3 cases. Major postoperative morbidity (Clavien-Dindo >= 3) was registered in two patients. One patient developed severe postoperative pancreatic fistula and delayed haemorrhage, who later succumbed due to poly organ failure. Histology analysis confirmed true venous invasion in all cases.
Conclusions : Peritoneal patch reconstruction for portal vein resection has proven valuable and cost-effective. Peritoneal patches seem appealing for vascular reconstruction due to their availability in the same operative field. The peritoneum is more resistant to infection than synthetic grafts, and the mesothelial lining is non-thrombogenic.
SESSION
BP Best video Presentation
Room A 3/23/2024 8:30 AM - 9:30 AM